ACO News

On February 15, 2016 the Florida Accountable Care services reached a milestone that sets precedent for the wave of the future in healthcare. Much like a presidential inauguration FACS kicked off its partnership with UnitedHealthcare. Alongside Primary care providers, Ancillary health providers, honored guest, U.S Sen. Bill Nelson (D-FL) and David Lewis—CEO of UnitedHealthcare.

The next big thing in health care is here and eyes are on Florida Accountable Care Services as it places itself at the forefront of the changing health care system. UnitedHealthcare recognized FACS for “partnering around the needs of society.” The partnership involves more than 20,000 people in central Florida. Starting April 1st 2016 the partnership will solidify and the real work begins for FACS to apply their expertise in health care innovation and patient-centered programs to improve the health of UnitedHealthCare participants and advance toward overall population health management.

UnitedHealthcare has been evaluating how to increase quality, reduce medical costs, and improve patient outcomes, as well as share risk and responsibility for controlling medical cost trends since 2010. UHC noted Accountable Care organizations (ACOs) to be an important element of its value based contracting strategy. With a goal set to increase collaboration between the health care community and emphasis on shared risk accountability for improved outcomes UnitedHealthcare saw value in a partnership with FACS.

FACS long-standing history proves that it has been successful in generating true savings through an independent Physician led and Physician governed membership and a robust clinical integration network. FACS achieved success when it saved the federal government $ 15 million dollars by streamlining care. Something UnitedHealthcare sees tremendous value in.

The day was marked by a sea of smiles, handshakes and joyous energy. The event was kicked off with a ribbon cutting ceremony to celebrate the grand opening of the Florida Emergent Care, located in the FACS hub building at the Medical Village in Winter Park, FL. A 24/7 care center hybrid between an emergency room and an urgent care facility that is able to provide services 10 times cheaper than going to an emergency room.

“These are big steps forwards,” said David Lewis CEO of UnitedHealthcare of Florida. This set the tone for the importance of the event. U.S Sen. Bill Nelson agreed stating in his speech: “The significance of today is that one of the largest health insurers in the state—with 3.5 million customers—United is teaming up with an ACO in order to bring those costs down and therefore to bring cost down in premiums.”

In response Dr. Sandeep Bajaj—Founder and CEO,FACS—stated: “We are very proud to work with them because I think that they’ll be toe to toe with us, as we want to challenge and push the envelope to make something really innovative and great for our patients. “

The event is a remarkable achievement for Florida Accountable Care Services since its inception in 2012. This is only one of many more achievements that are to come and to prove that FACS is working towards improving access to health information so that physicians are better able to coordinate a patient’s care across the care continuum. A major and notable part of the continuum is that FACS’ electronic health records are linked to the states system which provides results in real time.

As the health care system continues to change FACS is determined to continue its innovative approach. It will move forward making ripples that turn into waves of change for the better of the community that it serves. Partnering with health care giant UnitedHealthCare is only the beginning. FACS has also partnered with Cigna and Aetna. In a statement Dr. Sandeep Bajaj said: “Together, we expect to achieve even better health outcomes and improve patient satisfaction, while reducing the overall cost of care.”

As 2014 draws to a close, we are finally beginning to see the results of some of the first, most basic types of studies that attempt to describe, characterize, or assess the progress of ACOs. Shortell, McClellan, Ramsay, Casalino, Ryan, and Copeland published such an article in the October 2014 issue of Health Services Research entitled “Physician Practice Participation in Accountable Care Organizations: The Emergence of the Unicorn.” They found that, to date, no studies had been published looking at the rate of individual physician practices joining or planning to join ACOs. Using data from the National Survey of Physician Organizations III (collected in 2012-2013), they were able to look at 1,183 practices that were in one of three groups: already in an ACO, planning to join an ACO within a year, or those that had no cur-rent plans to join an ACO. About a quarter of the practices were already participating in an ACO, with another 16% planning to join an ACO within a year. Nearly 75% of practices participating in ACOs had 100 or more physicians, even though nearly half of practices in the US are comprised of 5 or fewer physicians. Practices in New England and the East South Central region of the United States were also more likely to join ACOs, as well as practices that receive patients from an IPA or PHO. The study found no statistically significant differences in ACO participation based on ownership structure or specialty mix. The authors stress that it is typical for large, well-networked practices to be the earlier adopters of the ACO model, but there is a growing need for longitudinal studies that are able to assess how early adopters are achieving the ACO “triple aim” of better quality, better health, and lower costs.

This article from December 2013 describes a cross-sectional study of all the accountable care organizations (ACOs) in the United States, as of August 2012. The researchers analyzed demographic and health care system characteristics for each ACO and were able to determine which factors were most associated with ACO presence. Many factors, such as competition and number of physician groups available, were found to have varying degrees of influence on ACO formation. For example, if fewer physician groups exist in an area, this may indicate that the groups are larger, leaving more opportunity for the presence of ACOs in a market. The 227 ACOs identified in the study were found to service nearly 1/3 of local areas, with over half of all Americans living in an area with at least one ACO. Furthermore, ACOs differed in their coverage, with most ACOs (37%) centralized in one area, while a full quarter of ACOs served eight or more areas. One indicator that significantly predicted presence of an ACO was an area with higher per capita Medicare costs, as well as those with less acute care beds. Regionally, the northeast featured the most ACOs, along with urban areas and areas of low poverty. This study is one of many that attempt to explain where (and why) ACOs are formed. To this point, this information has been fragmented and difficult to compile for adequate analysis. As more literature emerges that discusses the many different aspects of ACO formation and presence, more detailed analysis can define what factors make ACOs successful in terms of performance and health outcomes.

Florida Accountable Care Services is very proud and extremely pleased to announce our selection on May 5th, 2013, by The Agency for Healthcare Administration (AHCA) and the Harris Corporation to become a Node on the State of Florida Health Information Exchange (FHIE). After completing a thorough review of all respondents, Florida Accountable Care Services was selected amongst many applicants because of our shared belief in the FACS Team and its sheer wherewithal and leadership potential to contribute to the success of the Statewide Health Network for Florida.

The Florida HIE provides health care professionals with a timely, secure, and authorized way to exchange patient health information through two services. The Patient Look-Up and Delivery (PLU) service is a “network of networks” that brings existing provider networks together to provide a statewide information highway for Florida’s health care professionals. Information is queried for treatment purposes with patient consent. The Direct Secure Messaging (DSM) service is a secure email service that allows users to send and receive email messages and attachments containing a patient’s clinical data. DSM can be used for purposes of treatment, payment, and operations.

More specifically, DSM offers a more secure and efficient method for two-way communication and transmission of protected health information (PHI) than fax, phone, regular mail, or courier. The ability to electronically transmit patient records facilitates coordinated patient care; enhances communication between providers and facilities; and can reduce duplicate procedures, tests, and medications. DSM also supports meaningful use by enabling the electronic exchange of clinical information like Continuity of Care Documents (CCDs) and referrals. The DSM Participant Directory contains a listing for every registered user that includes DSM address, physical address, and phone/fax numbers. The Participant Directory allows other users to search for individual providers or organizations by name and/or location. DSM sends automatic read receipts whenever a message you have sent is opened and provides notifications to your regular email upon receipt of a message in your DSM inbox.

The sharing of patient data through the PLU service will lead to better quality health care for Florida’s citizens and specifically our Patients. PLU facilitates patient care, diagnosis, and course of treatment; enhances communications between hospitals, labs, pharmacies, and referring physicians; and reduces orders for duplicate tests, procedures, and medications. Enabling health care providers to access clinical records from multiple sources at the point of care will reduce costs and improve health care outcomes for patients by giving providers the most up-to-date and complete medical record possible. Our partners, ACHA and the Harris Corporation are no strangers to such large scale projects as this one. ACHA as most of you know is Florida’s chief health policy and planning entity for the state. In March 2010, the Agency was notified that it was awarded $20.7 million in federal funding to be used over a four-year period for the purpose of supporting statewide HIE. Harris Corporation is an international communications and information technology company. Harris Healthcare Solutions has been awarded a four-year contract by Florida’s the Agency for Health Care Administration (Agency) to establish and run the Florida HIE.

Over the coming months ACHA, FACS, and Harris Corporation will be working closely together on the full scale implementation and roll out to all our Physicians, as well as integrate our connections with Physicians and Hospitals in Alabama and Georgia and additional states coming on board in the near future. This is a testament to the staff of FACS (Vikram Saini), Guardian Health Solutions (Pranam Ben), and our IT/Sales consultant (Don Smith) that this major opportunity was obtained. As the only ACO Organization awarded this honor, It also points to the good work that our staff and associates are capable of as well as the opportunities that are available in this newly emerging health care market.

On May 18th, at the beautiful Grand Bohemian hotel on a Saturday Afternoon, FACS along with over 30 primary care physicians, ancillary health providers, and several honored guests held its second annual ACO Summit for Florida Physicians Trust and the newly formed Central Florida Physicians Trust. We began the day with a discussion regarding ACO updates / paradigm shifts in the local market by Dr. Sandeep Bajaj, which transitioned quite nicely into a discussion regarding commercial ACO platforms by our honored guest Ms. Ruth Fricke, Senior Vice-President for Aetna Healthcare. Members of the FACS team Dr. Richard Cairl and Vikram Saini discussed the ACO quality metrics and some of the shared savings calculations, while we also received updates regarding the Guardian Health Solution. Our day was bookended by our keynote address from Florida Physicians Trust Medical Director, Dr. William Silverman of Lake Howell Family Medicine and myself, Dr. Dwight Jones.

WASHINGTON — Physician-led accountable care organizations (ACOs) could have more opportunities to create savings in patient care with a little help from health insurers, a leading health reform expert said Wednesday.

Doctor-centric ACOs can do a better job at controlling costs than hospital-led organizations, Paul Ginsburg, PhD, president of the Center for Studying Health System Change here, said at an ACO summit hosted by America’s Health Insurance Plans.

Entrepreneurial insurance companies can offer loans to provider groups to expand or re-engineer to become ACOs through Medicare or commercial payers, Ginsburg said. Others can create innovative programs that have physicians take additional risk to improve outcomes and lower costs for patients.

“I think physician-led ACOs inherently make markets more competitive because they have an opportunity to shift patients toward higher-value hospitals,” Ginsburg said. “It means that a hospital market that might not have large competition going, all of a sudden, if there’s a physician-led ACO, those hospitals have to compete on price for the allegiance of those physician-led ACOs.” Unlike in hospital-led ACOs, doctor-led ACOs aren’t compromised financially by reducing hospital admissions and emergency department visits, he pointed out.

In fact, physician-led ACOs already outnumber their hospital counterparts, the latest data from the Centers for Medicare and Medicaid Services (CMS) show. However, doctor-organized groups typically treat fewer patients than those formed by hospitals.

Charlie Baker, former Secretary of Health and Human Services Secretary in Massachusetts, noted that nearly every shared-risk model in Medicare Advantage is with physician groups and not hospitals, he says, because insurers know that’s how to save money.

Baker said he believes there will be more growth in small providers pooling resources to become ACOs. “My big fear is they’re starting behind the larger players, way behind,” Baker said. Physician groups are still skeptical of quality metrics used to determine the shared savings in ACOs, Ginsburg said.

However, CMS rules on ACOs favor hospital-led organizations. “The CMS rules are making it exceedingly difficult for an independent physician group to form an ACO,” Baker said. To that point, Ginsburg noted the federal government can play a larger role in facilitating physician-led ACOs.

“I think of the federal support for the HMOs in the 1970s as to whether it’d be feasible to have the federal government support the development of physician organizations as an investment for viable markets in the future,” Ginsburg said.

No matter what happens, whatever strategy emerges to control costs must tackle provider payments — an area public and private payers seem to be in agreement on.

Jeff Goldsmith, PhD, professor of public health sciences at the University of Virginia in Charlottesville, called for more physician independent practice associations and doctor-sponsored health plans. He doesn’t believe hospitals should be the center for managing clinical risk in the health system.

“I think hospitals have an valuable important role to play, but to assume they’re going to voluntarily shrink their own franchise defies belief,” Goldsmith said.